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FEMA-EC970707The City With A Beautiful Future BUILDING PERMIT APPLICATION � JU 2 A 55 Print or Type in a Clear, Legible Manner Job Address: ��—/� �/ Shy/� GST Date: Lot: .11171 Block: "log Subdivision: Phase or Section Number: Owner �j� �' ��.� Address: ��j,J� J� Phone #: Contractor: mss,, Address: Phone #: z17/ Description of Work to be Done Class of Work: ew ❑ Addition ❑ Alteration ❑ Repair AA p El Demolition Area of Building in Square Feet First Floor .187" Garage ,&Zz_ Value of Work to be Performed Second Floor �77� Other 4?!e) No ELEVATION CERTIFICATE O.M.B. May 1077 Expires May 31, 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM r ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMB). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION j FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER rt) 41 J "e.) V),AJ STREET ADDRESS (Includin Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY NAIC NUMBER t 6L S M i L..L. zu 9.7— OTHER DESCRIPTION (Lot and Block Numbers, etc.) Lo -r y- [�l►t A Fp 2W,a �l S AT (tt��'12 cf-+BSc. CITY STATE ZIP CODE �� Pf'fr'LL 1 SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION (in AO Zones, use depth) L� 01-1c) 0 0 (n P I% I l 5 199 Plr 4-4+ o 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE) jNGVD '29 ❑ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: 11__I I I 1. ❑ feet NGVD (or other FIRM datum–see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level __L— . 2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of L_❑_41411A feet NGVD (or other FIRM datum–see Section B, Item 7). (b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I I I I I � .❑ feet NGVD (or other FIRM datum–see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is W .❑ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is _I 1. L) feet above ❑ or below F (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:t.P1GVD '29 ❑ Other (describe under Comments on Page 2). (NOTE. If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: Yes ❑ No (See Instructions on Page 4) 5. The reference level elevation is based on: ctual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: 44�� . U feet NGVD (or other FIRM datum see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I I I . ❑ feet NGVD (or other FIRM datum–see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones Ai—A30, AE, AH, A (with 13FE),V1—V30,VE, and V (with BFE) Community officials who are authorized by local law or ordinance to provide floodplain management informatio6 sl certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a 1**— 40 owner's representative may also sign the certification. ,f4,0 Fo •: Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaw enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), thej r4 included in the certification under Comments below. The diagram number, Section C, Item 1, must still be en a ♦�FESS�.•:��Y I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the dat b�uP` I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 10" 0Gro1j Q M R. PL. S. �o. S034 - C TIFIER'S NAME LICENSE NUMBER (or A ix Seal � s+crer� ero�essiohaA 14AA Surycgo,r- S- oval 1 , 'ASSoc, Akc s TITLE COMPANY NAAE o —Bb - Zt3053 Dai as �ekCtS %522i� AMNAU CITY (j�J STATE/ ! ZIP -7SI / 1 DATE PH�� Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS: ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES REFERENCE REFERENCE BASE LEVEL REFERENCE LEVEL FLOOD LEVEL ELEVATION BASE BASE ADJACENT: A.. REFERENCE FLOOD FLOOD' ELEVATION REFERENCE ADJACENT GRADE '�` LEVEL ELEVATION LEVEL GRADE .::.::::::::.:`•5,•!':':.'':::�; ��'. :" �' ADJACENT:: GRADE , The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 APPPDX LCC. OF 100 YR. FLOOD PL AIN GOLF CaA'Se LNSCP. EASMT. / .A2A.I / /� \ /``` � PATIO NORTH SITE PLAN scALc- r - 2a -o, LOT 44, BLOCK A FAIRWAYS AT 121VEPCHASE DALLAS COLINTY COPPELL, TEXAS A CADNC. C Cot'r- WALK IVE C %,,c- CITY, REVIEWED Ay" DATE Approval --'L, izjlans and specifications shah not de construed L(� mean construction in direct c'on- filict( with the City of Coppell Building Codes ano ?Oninp, Ordinance-, PLANS ARF RMEWFD FCJ" APPROVAL OF SINGLE A �M t LY RESIDENCE ONLY, Y - -f. r T, ' � J, i " 1) E P'A CT. IONS OR C!",1.1'-OUIFS ON PLOT PLAN HAVE NOT BEEN REVIEWED AND ARE N a APPROVED® Ni -A. &- - , p. fv1fN1MtJM f f WHA 80AkD SURVEY UQUEM ) STREET CUT BERKSHIRE LANE